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General NPI Number Information
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NPI Number | 1982209508
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Entity Type | Organization
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Legal Business Name | BROOKLYN PDX ACUPUNCTURE LLC
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 3880 SE BROOKLYN ST
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City | PORTLAND
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State | OR
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Zip | 97202-1674
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Country | US
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Telephone | 503-236-2389
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Fax |
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Provider Business Mailing Address
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Address Line | 1430 SE 14TH AVE APT 110
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City | PORTLAND
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State | OR
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Zip | 97214-3658
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Country | US
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Telephone | 203-913-2829
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Fax |
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Authorized Official
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Title or Position | CO-CEO
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Name | MEGHAN NOLAN
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Credential | LAC
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Telephone | 203-913-2829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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